PRESIDENTIAL SYMPOSIUM: FRAMING, BRIDGING, AND TRAVERSING SOCIAL DETERMINANTS OF HEALTH, DISPARITIES, AND INEQUITIES IN OLDER ADULTS

Abstract In alignment with the theme of this year’s conference, Building Bridges>Catalyzing Research>Empowering All Ages, this symposium focuses on research that frames, bridges, and transverses various constructs of the social determinants of health, intersectional frameworks, and inequities that impact older adults at various times in life from mid to older adulthood through death. We start with a framework for how to consider social and structural conditions in which people live and the cumulative effects that an individual’s life course might impact their trajectory with Alzheimer’s disease and other related dementias and their families. Continuing on with the theme of family, dementia, and caregivers, we delve into the differences in caregiver burden across and within gender and racial/ethnic groups, looking at the linkage with financial, emotional, and physical burdens. From there, we go on to explore whether there is an association between negative family interactions and mental health outcomes and discuss how those outcomes might vary by race and ethnicity. Building upon several concepts in these first three papers, we will discuss how one can evaluate the intersectional impact of race and gender on end-of-life outcomes including pain, anxiety/depression, patient autonomy, and overall care quality. Our last speaker will share intriguing, and somewhat unexpected findings related to social inequities on health from midlife to death and the impact of early exposure to socioeconomic disadvantages might have on disparities. Given the importance of reducing inequities to improve health outcomes, this HS section Presidential Symposium is sure to challenge and enhance our thinking.


United States, 2. AARP Public Policy Institute, Washington, District of Columbia, United States
There have been significant federal and state policy developments since the 2019 update of Valuing the Invaluable.Many inroads have been made in recognizing and supporting family caregivers, but additional steps can be taken at the federal and state levels, and even in the private sector.The National Strategy to Support Family Caregivers, released in September 2022, lays out a unified approach in five organizing goals to achieving this improvement in support for family caregivers.The policy and practice recommendations highlighted in the Valuing the Invaluable: 2023 Update reflect the National Strategy goals.In this presentation, recent policy changes will be summarized that support caregivers and their care recipients in the health care and LTSS systems, which provide financial relief for caregiving, and help working caregivers stay in the workforce.Then the increasing visibility of the family caregiving experience in media and the arts will be explored.This visibility is essential for bringing broader attention to all aspects of caregiving, normalizing the care experience, and eliminating stigma around disability and dementia.Lastly, policy recommendations for building on the National Strategy and bolstering support for family caregivers and care recipients will be detailed for discussion.

YOU ARE ONLY MY STUDENT FOR A LITTLE WHILE; YOU ARE MY COLLEAGUE FOR LIFE Harvey Sterns, The University of Akron, Akron, Ohio, United States
The philosophy of you are my student for a little whileyou are my colleague for life was shared with me by my major professor Paul Baltes.This has been my approach over my 50+ year career.I have had a number of significant mentors and have had many great students.In the spirit of this award, I will share my understanding of mentorship.

PRESIDENTIAL SYMPOSIUM: FRAMING, BRIDGING, AND TRAVERSING SOCIAL DETERMINANTS OF HEALTH, DISPARITIES, AND INEQUITIES IN OLDER ADULTS
Chair: Deb Bakerjian Discussant: Mo-kyung Sin In alignment with the theme of this year's conference, Building Bridges>Catalyzing Research>Empowering All Ages, this symposium focuses on research that frames, bridges, and transverses various constructs of the social determinants of health, intersectional frameworks, and inequities that impact older adults at various times in life from mid to older adulthood through death.We start with a framework for how to consider social and structural conditions in which people live and the cumulative effects that an individual's life course might impact their trajectory with Alzheimer's disease and other related dementias and their families.Continuing on with the theme of family, dementia, and caregivers, we delve into the differences in caregiver burden across and within gender and racial/ethnic groups, looking at the linkage with financial, emotional, and physical burdens.From there, we go on to explore whether there is an association between negative family interactions and mental health outcomes and discuss how those outcomes might vary by race and ethnicity.Building upon several concepts in these first three papers, we will discuss how one can evaluate the intersectional impact of race and gender on end-of-life outcomes including pain, anxiety/depression, patient autonomy, and overall care quality.Our last speaker will share intriguing, and somewhat unexpected findings related to social inequities on health from midlife to death and the impact of early exposure to socioeconomic disadvantages might have on disparities.Given the importance of reducing inequities to improve health outcomes, this HS section Presidential Symposium is sure to challenge and enhance our thinking.

A FRAMEWORK FOR CONSIDERING SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH IN ALZHEIMER'S DISEASE RESEARCH AND CARE Shana Stites, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Social and structural determinants of health (SSDoH) refer to the conditions in which individuals live, work, and age.SSDoH can have cumulative effects across the life course that can have an impact on outcomes for persons with Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) and their family members.In our two-part presentation, we first describe the theoretical and empirical underpinnings of core SSDoH constructs in AD/ ADRD research and practice.We review empirical support for the specific SSDoH that we include and highlight their relevance in the care of older adults.The core set of SSDoH that we focus on have been identified as being important across a broad range of socially and culturally heterogeneous populations and we walk through the strengths and limits of this.We also report results from data obtained during a pilot test of these measures in the UPenn Alzheimer's Disease Research Center (ADRC), which offer empirical support of their cultural appropriateness.We outline a rationale for the consideration of SSDoH in aging and AD/ADRD research, policy, and practice.In the second part of our presentation, we offer a case example of how sex, gender, and sexual orientation operate as core SSDoH in the healthy, aging population and in the care of older adults.In our case example, we also overview definitions, clinical considerations, and policy applications.
Abstract citation ID: igad104.0801Caregivers may be at different risks of various types of burdens by virtue of their gender and racial/ethnic status.This study explored the differences in caregiving burdens among caregivers to people with dementia across the intersectionality of race and gender.Using Round 5 (conducted in 2015) and Round 7 (conducted in 2017) of the National Study of Caregiving and National Health and Aging Trends Study data, the study examined differences in caregiver burdens across and within different gender and racial/ ethnic groups, within the realms of financial, emotional, and physical burdens.The sample consisted of 1,206 caregivers who provided services to Medicare beneficiaries.Logistic regressions were performed to assess the three types of burdens each subgroup was experiencing.Results indicated that within the intersectionality framework, compared to White female caregivers, Black male caregivers were 3.3 times (95% confidence interval [CI] 1.77-6.22)more likely to experience financial burden, and Black female caregivers were 54% (95% CI 0.28-0.76)less likely to experience physical burden.Surprisingly, compared to White female caregivers, all the other groups were 37% (95% CI 0.41-0.95) to 71% (95% CI 0.15-0.56)less likely to have emotional burden.The findings highlighted that Black male caregivers are experiencing financial burden and White female caregivers are experiencing emotional burden disproportionately.To develop effective interventions and programs for dementia caregivers, a special focus should be put on monitoring the differences in the types of burdens that the above-mentioned population subgroups experience.Studies generally show that negative social interactions are detrimental to mental health for older adults.Furthermore, empirical evidence suggests that negative interactions may function differently in relation to mental health across racial/ ethnic groups given their unique life circumstances and social conditions.This study examines whether the association between negative family interactions and mental health outcomes varies by race and ethnicity.Samples of older African Americans, Caribbean Blacks, and non-Latino Whites aged 55 and older were drawn from the National Survey of American Life (N = 1,439).Mental health variables included depressive symptoms, any lifetime disorder according to The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and number of lifetime DSM-IV disorders.Regression models were used to test the study aim.Analyses indicated that negative interactions with family were positively associated with all 3 mental health outcomes.Several racial/ethnic differences emerged.The association between negative family interactions and depressive symptoms was stronger among Whites than African Americans.While negative family interactions were positively associated with number of disorders among Caribbean Blacks, negative interactions were unrelated to number of disorders among African Americans.This study demonstrates the racial and ethnic differences in diverse aging populations and the importance of recognizing the heterogeneity of the Black American population in minority research.Clinical practice should focus on reducing negative family interactions, and future research should examine whether psychosocial resources (e.g., stress appraisals, neighborhood social cohesion) can attenuate the association between negative family interactions and mental health for older African Americans.